2012年NCCN指南结直肠癌新辅助及解救化疗方案变更与解读

Interpretations of the changes of colorectal cancer neo-adjurant and salvage chemotherapy regimen in 2012 version NCCN guideline

2012年美国国家癌症综合网(National Comprehensive Cancer Network,NCCN)指南中结直肠癌新辅助和解救化疗方案出现了一些变更。由于在两项Ⅲ期随机对照研究中西妥昔单抗无法在奥沙利铂化疗的基础上进一步延长病人生存期,FOLFOX联合西妥昔单抗的方案被从KRAS野生型晚期结直肠癌病人的解救化疗和非转化性新辅助化疗中剔除。但在转化性新辅助化疗中,EGFR单抗联合奥沙利铂为基础的化疗方案仍具有合理性。卡培他滨联合贝伐珠单抗具有良好安全性增加为不能耐受高强度化疗的进展期或转移性结直肠癌的一种初始治疗选择。Ⅱ/Ⅲ期直肠癌术前同步放化疗首选卡培他滨或静脉输注氟尿嘧啶联合放疗。3项研究结果表明,在直肠癌新辅助同步放化疗中卡培他滨或静脉输注5-FU联合放疗为目前首选方案,增加奥沙利铂并不能进一步增加近期疗效。

Some changes have been made on the colorectal cancer neo-adjuvant and the salvage chemotherapy regimens in the 2012 version of NCCN guideline. The combination of FOLFOX with cetuximab was removed from the salvage regimens and non-conversional neo-adjuvant chemotherapy regimens for KRAS wild type advanced colorectal cancer patients, because two phase Ⅲ randomized control trials presented with negative results. However, there are still rationales for the combination of oxaliplatin based regimens with EGFR antibody in the Conversional neo-adjuvant chemotherapy. The combination of capecitabine withbevacizumab is well tolerated, which is recommended as one of the initial treatment options for the patients who can＇ t tolerate intensive chemotherapy with advanced colorectal cancer. The concurrent chemoradiotherapy with capecitabine or infusional 5fluorouracil is recommended as the prior option for the patients with stage lI or In rectal cancer. Capecitabine or infusional 5fluorouracil concurrent with radiotherapy is the prior neo-adjuvant regimen for the patients with rectal cancer, based on the results of three trials. Oxaliplatin can＇t produce additional short term benefits.